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General NPI Number Information
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NPI Number | 1780583757
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Entity Type | Organization
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Legal Business Name | WILLOW & ROAN WELLNESS STUDIO PLLC
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Dates
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Enumeration Date | 11/04/2026
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Last Update Date | 11/04/2026
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Provider Practice Location Address
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Address Line | 601 AMON PARK DR
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City | RICHLAND
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State | WA
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Zip | 99352-5549
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Country | US
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Telephone | 509-492-0529
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Fax |
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Provider Business Mailing Address
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Address Line | 10107 REDBUD DR
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City | PASCO
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State | WA
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Zip | 99301-6927
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/FOUNDER
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Name | NICOLE M HART
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Credential | PMHNP
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Telephone | 509-492-0529
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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